Similar short-term improvements after Roux-en-Y, sleeve gastrectomy

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Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

ORLANDO -- Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) were found to be equally effective for the short-term improvement of beta-cell function, a new study reported.

Jamie Mullally, MD, of Columbia University College of Physicians & Surgeons in New York City, and colleagues found that patients with type 2 diabetes who underwent SG and RYGB procedures also had similar fasting glucose reductions post-surgery (40.1 mg/dL for SG; 43.2 mg/dL for RYGB, P=0.89).

In addition, insulin secretion in relation to insulin sensitivity, measured by a disposition index, saw similar improvements between SG and RYGB groups post-surgery, without statistically significant differences (20.2-163.3, P=0.03 for SG; 32.3-211.5, P=0.04 for RYGB, P=0.70), Mullally reported in a presentation here at ENDO 2017.

"Roux-en-Y gastric bypass surgery has declined in popularity in recent years, accounting for 37% of surgeries in 2011, and about 23% of surgeries in 2015," she explained, quoting data from the American Society for Metabolic & Bariatric Surgery.

"At the same time, sleeve gastrectomy has surged in popularity, accounting for only 18% of surgeries in 2011, and up to 54% by 2015, and it has continued to grow in popularity," she added, noting that sleeve gastrectomy may be considered a safer, "less drastic operation."

However, if the main goal of the surgery is to treat type 2 diabetes, "that favors gastric bypass over sleeve gastrectomy because gastric bypass engages a number of weight-independent, anti-diabetes mechanisms that contribute to its benefits, and those are not as clearly established in sleeve gastrectomy," David Cummings, MD, of the University of Washington School of Medicine, noted in a recent MedPage TodayHot Topicspresentation.

Mullally's group followed 20 diabetic patients who were not on insulin. Baseline characteristics were similar between the groups, including a mean age of 45.1, body mass index of 44.7, HbA1C of 7.4%, fasting glucose of 161.4 mg/dL, and diabetes duration of 4.2 years.

Oral diabetes medications were withheld 3 days prior to the analysis. Matched participants underwent either an SG procedure (n=10) or RYGB surgery (n=10).

At week 3 prior to surgery and after surgery, the researchers administered insulin-supplemented intravenous glucose tolerance tests, which included injecting glucose at baseline and injecting insulin at 20 minutes. The researchers used a Bergman minimal model analysis for their analysis.

About 3 weeks after surgery, the mean weight loss for both groups was also similar (8.9% for SG; 8.4% for RYGB, P=0.60).

Meeting attendees questioned Mullally about the durability of re-admission with SG versus RYGB, referencing the recent results of the STAMPEDE trial, which found that the combination of either bariatric procedure with intensive medical treatment offered better outcomes over medical treatment alone.

Mullally answered that the current trial and STAMPEDE were not designed to measure for the same outcomes: "Previous studies really do show that Roux-en-Y gastric bypass seems to be a superior metabolic surgery in the longer-term [compared with sleeve gastrectomy]."

She said the group will now continue the study for the longer term, particularly to see if RYGB prevails with better glycemic outcomes, as it has in terms of sustained weight loss. Intravenous and oral nutrient challenges will be included in future study protocols, Mullally added.

Mullally reported having no relevant relationships with industry, but some co-authors disclosed relationships with EndObetes, ValenTx, and Covidien/Medtronic.

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